Implementing Resistance Exercise to Reduce Frailty in Older Adult Medicaid Waiver Recipients

The older adult population in the United States is rapidly growing. Approximately 10,000 people turn 65 every day in the USA. One of the most debilitating aspects of aging is the development of the frailty syndrome that contributes to functional limitations and an increased risk for nursing home placement. Muscle strength deficits are one component of the frailty syndrome. Resistance exercise has been shown to be effective in improving the strength and functioning of older adults, however, the impact of resistance exercise on the frailty syndrome remains unclear. Furthermore, it is difficult for frail, commonly homebound older adults to participate in resistance exercise programs because they are usually offered in community settings. Additionally, these community-based programs are often geared towards community-dwelling healthy older adults and are not targeted for the frail older adult. Thus, there exists a significant need to develop and lead innovative evidence-based approaches to provide this marginalized population with access to programs to improve their health and safety, while facilitating continued aging-in-place. Recently, Dr. Danilovich completed a 12 week pilot study investigating the feasibility of offering a resistance exercise program, Strong for Life (SFL), for Community Care Program clients. In this pilot work, Home Care Aides were trained to lead Strong for Life with their clients three times per week for 12 weeks. Overall, home care aides were able to implement the program safely with their clients and both participant groups reported high levels of satisfaction with the program. We identified that a strong majority (72%) of clients met the criteria for the frailty phenotype and an overwhelming majority needed to modify or omit exercises in the program because of their physical limitations. Thus, there is a need to develop an intervention specifically targeted for these clients who have the frailty syndrome. We propose to develop an exercise intervention that can reduce frailty in older adults to facilitate their ability to age-inplace. The long-term objective of this work is to develop a package of interventions that can be administered within the existing Medicaid Home and Community Based Services (HCBS) Waiver programs. The specific goal of this proposal is to develop a resistance exercise intervention to reduce frailty in older adults receiving long term care services in their home through the Illinois Community Care Program, a HCBS Waiver Program.